340: Freezing Of Gait Starts Before The First Freeze With Becky Farley, PhD, MS, PT, And Jennifer Bazan-Wigle, PT, DPT, CEEAA

What if freezing of gait isn't a late-stage problem at all, but something already taking shape at the moment of a Parkinson's diagnosis? In this episode, hosts Erin Gallardo, PT, DPT, NCS, and Claire McLean, PT, DPT, NCS, talk with Becky Farley, PhD, MS, PT, founder of Parkinson Wellness Recovery (PWR!), and Jennifer Bazan-Wigle, PT, DPT, CEEAA, physical therapist at the PWR!Gym in Tucson, Arizona, about what the PWR! team learned while building their World Parkinson Congress poster on personalized freezing of gait interventions for freezers and non-freezers. Becky explains how digging into the underlying mechanisms convinced her that gait and balance must be targeted seriously from diagnosis. Those mechanisms include interference and loss of automaticity, perceptual processing dysfunction, abnormal coupling of posture and gait, and executive dysfunction. She also explains why she now adds psychological stress to that list and why stress management, medication optimization, and aerobic intensity form the foundation for building resilience. Jen describes how the PWR! team flags higher-risk patients early, how they run consecutive-day freezing intensives each month within an insurance-based model, and why group classes may be key to holding onto those gains. Claire shares how her team at Rogue screens for freezing using 360-degree turns and step counts during gait speed testing, and why anxious movers often resist the very classes that would help them most. The conversation also covers a new standardized freezing of gait assessment now in validation, a large South Korean cohort linking earlier rehab referral to lower mortality, and why the ability to control rhythm, including moving slower than comfortable, may be an underused screen and treatment target. Resources mentioned in the episode, including an image of the poster and Becky's reference list, are linked below.

https://www.pwr4life.org/fog/

Freezing of Gait (FOG) Poster, FOG Assessment & Video examples, FOG Mechanisms w/ Video Examples

FOG Resources from WPC for our FOG posters

This includes a page of NEW FOG relevant REFS and LINKS.

https://www.pwr4life.org/floortransfers/

References:

Gülke E, Lewis SJG. What is new in Freezing of Gait?. J Neurol. 2026;273(4):222. Published 2026 Mar 21.

doi:10.1007/s00415-026-13765-6

Gilat M, Nonnekes J, Factor SA, et al. An updated definition of freezing of gait. Nat Rev Neurol.

2026;22(3):172-181. doi:10.1038/s41582-025-01179-3

Tosserams A, Fasano A, Gilat M, et al. Management of freezing of gait - mechanism-based practical

recommendations. Nat Rev Neurol. 2025;21(6):327-344. doi:10.1038/s41582-025-01079-6

Gaveel TJ, Postma EM, Bloem BR, et al. The SENSS (Stress, Exercise, Nutrition, Sleep, Self-management)

study: study protocol for a randomized controlled trial to evaluate an integrated, personalized and stepped care

lifestyle approach for people with Parkinson's disease. Front Neurol. 2026;17:1752073. Published 2026 Mar 3.

doi:10.3389/fneur.2026.1752073

Goltz F, van der Heide A, Helmich RC. Alleviating Stress in Parkinson's Disease: Symptomatic Treatment,

Disease Modification, or Both?. J Parkinsons Dis. 2024;14(s1):S147-S158. doi:10.3233/JPD-230211

Johansson ME, Toni I, Bloem BR, Helmich RC. Parkinson's disease progression is shaped by longitudinal

changes in cerebral compensation. Brain. 2026;149(1):194-208. doi:10.1093/brain/awaf302

Lindholm B, Hagell P, Odin P, et al. Balance and gait disorders in de novo Parkinson's disease: support for

early rehabilitation. J Neurol. 2024;272(1):11. Published 2024 Dec 12. doi:10.1007/s00415-024-12804-4

Tosserams A, Bloem BR, Ehgoetz Martens KA, et al. Modulating arousal to overcome gait impairments in

Parkinson's disease: how the noradrenergic system may act as a double-edged sword. Transl Neurodegener.

2023;12(1):15. Published 2023 Mar 26. doi:10.1186/s40035-023-00347-z

Tosserams A, Fasano A, Gilat M, et al. Management of freezing of gait - mechanism-based practical

recommendations. Nat Rev Neurol. 2025;21(6):327-344. doi:10.1038/s41582-025-01079-6

Yoon, S.Y., Chang, SY., Heo, SJ. et al. Timing of rehabilitation therapy initiation and all-cause mortality in

parkinson’s disease: nationwide cohort study. npj Parkinsons Dis. (2026). https://doi.org/10.1038/s41531-026-

01495-5

Zhang M, Zhang Y, Zhang Z, et al. Effects of mindfulness-based exercise on Parkinson's disease and

Alzheimer's disease: a systematic review and meta-analysis. Front Neurol. 2

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